Drug interactions
Hydromorphone + Ketamine
Severity: Major
Hydromorphone and Ketamine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Ketamine combined with an opioid can increase sedation and respiratory depression, although ketamine is often used to reduce opioid requirements. Ketamine may also cause hallucinations, blood pressure changes and dissociation that complicate assessment of sedation.
What this interaction means in plain words
Hydromorphone and Ketamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Hydromorphone belongs to Musculoskeletal; Ketamine belongs to Central Nervous System.
Why it happens
Additive CNS depression from opioid receptor agonism and NMDA receptor antagonism.
What to do
Use only with continuous monitoring of sedation, respiration and oxygen saturation, and consider reducing the opioid dose. Ensure resuscitation capability in procedural use.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Other interactions of Ketamine
Frequently asked questions
Can I take Hydromorphone with Ketamine?
MediHelp rates the interaction as major. Hydromorphone and Ketamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Ketamine combined with an opioid can increase sedation and respiratory depression, although ketamine is often used to reduce opioid requirements. Ketamine may also cause hallucinations, blood pressure changes and dissociation that complicate assessment of sedation.
How serious is the interaction between Hydromorphone and Ketamine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use only with continuous monitoring of sedation, respiration and oxygen saturation, and consider reducing the opioid dose. Ensure resuscitation capability in procedural use.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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